That dry, itchy scalp might not be dry at all

Dr. Crutchfield, I seem to be having a problem
with dandruff and a dry, itchy scalp, especially this winter. Can you help me?

Your concern over a dry, itchy scalp is a very common one. In
fact, I see several patients every day with the same complaint.

I tell patients that when it comes to treating dry, itchy
scalps, I have good news and I have bad news. The bad news is that there is no
cure for the condition, but the good news is that it can be managed and
controlled to the point where it seems like it does not exist.

The surprising fact is that the condition that everyone seems to
think of as dry, itchy scalp is not dry at all. It is a unique type of
eczema (also known as dermatitis) that makes the scalp seem like it is dry
because it produces lots of flakes.

The flakes are not a
result of the skin being dry; rather, the skin grows too fast as a response to
inflammation in the scalp. Sheets of skin pile up because they can’t be shed
quickly enough. The inflammation is driven in part by the oil production or
sebum in the scalp.

This massive amount of skin flakes tricks us into thinking it is
dry skin when it really is not. It is a very common skin condition called
“seborrheic dermatitis.” The condition is so common that it probably affects 25
percent of all people to some degree. It can occur on the scalp, face
(especially sides of the nose), eyebrows, ears, chest, belly button, groin,
armpits, and even the backside’s “gluteal cleft.”

For now, I will only talk about seborrheic dermatitis when it
occurs on the scalp. The familiar, non-medical name of seborrheic dermatitis
when it happens on the scalp is dandruff. It is a common skin disease that causes
the skin to be red, itchy and flakey.

Seborrheic dermatitis can wax and wane and appear and disappear
at any time. Sometimes the condition will resolve without treatment, but more
often than not it may require medical treatment.

Seborrheic dermatitis can occur in all people. In babies, it is
commonly called “cradle cap.” It can also occur in a baby’s diaper area. It
tends to occur most often in infancy and adulthood and in men more than women.
It is more common among family members, in people with oily skin, and for some
odd reason in people with Parkinson’s disease and HIV.

The condition is harmless and not contagious, although it
certainly is a nuisance. The constant itching and abundant skin flakes can be
extremely problematic and embarrassing.

Interestingly, the exact cause of seborrheic dermatitis is still
not completely understood. Perhaps the excess oil in our skin serves as a food
source for yeast that commonly live on everyone’s skin. The yeast grow, and for
some unknown reason some people have a brisk reaction to the larger population
of yeast on the surface of the skin. This response comes in the form of
inflammation (redness, flaking and itching).

The yeast component is only a part of the problem. The other
part is purely genetic, and the common areas are prone to inflammation with or
without yeast. The diagnosis can be made easily by an examination by a doctor,
especially a dermatologist.

As mentioned earlier, there is no cure for seborrheic dermatitis.
The goal is management and control of the condition until it is unnoticeable
and no longer a nuisance.

For scalp seborrheic dermatitis, I have a two-part treatment
plan. First, let me say that I am not a big fan of using a hair shampoo to
treat a skin condition. I recommend a medicated oil applied once per week
to reduce and maintain scalp inflammation. This part is the maintenance
program.

Washing one’s hair weekly is also very important. I recognize
that weekly hair washing may be a challenge for some, but it is essential to
clean the scalp skin and wash away the dead skin and flakes that are
continually building up.

Secondly, I have a very potent topical treatment to use for five
days if the condition should flare up and break through the maintenance
program. Three two-treatment steps work exceptionally well.

If you or a loved one has dry, itchy scalp, talk to your doctor
to see if it really is the medical condition called seborrheic dermatitis. If
it is, rest assured there are excellent treatment programs to make the
embarrassing and troubling situation much better to the point of seeming not to
be there at all.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations, and president of the Minnesota Association of Black Physicians.